FAQ – Dental Topics of Interest

WHAT IS A PEDIATRIC DENTIST?
          The American Academy of Pediatric Dentistry says, “Pediatric dentists are the pediatricians of dentistry.” “Pediatric dentistry is the specialty of dentistry that focuses on the oral health and unique needs of your children. After completing a four-year dental school curriculum, two to three additional years of rigorous training is required to become a pediatric dentist. This specialized program of study and hands-on experience prepares pediatric dentists to meet the unique needs of your infants, children and adolescents, including persons with special health care needs.”
            The professionals of Sonoran Center for Pediatric Dentistry, P.C. are concerned about your child’s total health care.  Good oral health is an important part of total health. Establishing us as your child’s, “Dental Home” provides us the opportunity to implement preventive dental health habits that keep a child free from dental/oral disease. We focus on prevention, early detection and treatment of dental diseases, and keep current on the latest advances in dentistry for children.

WHY SHOULD I TAKE MY CHILD TO A PEDIATRIC DENTIST?
            A pediatric dentist is a special person who has not only completed a basic 3-4 year program in dentistry, but has completed an additional 2 years of specialized training concentrating on the specialized needs and treatment of infants, children, teenagers and those with special needs.  Unlike general or family dentists who might treat some children, the pediatric dentist is trained to treat all types of children in all types of circumstances. Treatment of children requires attention to the individualized requirements of the growing child.  The pediatric dentist is the only dentist specially trained to handle those specialized requirements.

WHEN SHOULD I TAKE MY CHILD TO THE PEDIATRIC DENTIST?
            Dental caries (cavities) may be the most prevalent infectious disease in our children.  Almost ½ of American children have cavities by the time they reach kindergarten age.  In order to reduce the incidence of cavities and to set your children towards a lifetime of optimal oral health, the American Academy of Pediatric Dentistry and the American Dental Association recommend that a child’s first visit to the dentist should be within 6 months after the first tooth erupts or by 1 year of age, whichever comes first.  This office supports the recommendations of both of these organizations and we look forward to evaluating your child by their first birthday. Early and regular preventive care will help protect your child’s smile.

WHY SO EARLY?
            Dental caries is an infectious disease that spreads from tooth to tooth.  Regular and early dental visits allow your child to begin a thorough prevention program.  Dental problems can begin early but most dental problems can be prevented or corrected with early intervention.  Of prime concern to the pediatric dentist is Early Childhood Caries (nursing bottle caries).  A child risks severe decay from using a bottle or sippy cup during naps, at night, or when continuously breast-feeding.  Earlier dental visits improve the chances of preventing dental problems.  Your child’s primary teeth (baby) serve many important functions including allowing for proper speech and mastication (chewing), and holding space for permanent teeth.

THE FIRST VISIT - WHAT SHOULD I TELL MY CHILD?
            You can help us make your child’s first dental visit as comfortable and enjoyable as possible.  Please talk to your child about the visit but discuss the visit in upbeat positive terms.  Do not go into great detail about what will occur.  Tell him or her that we are going to “count” their teeth and that we might “take pictures” of the teeth.  Please refrain from using any words that might cause unnecessary fear such as “needle”, “pull” or “drill”.  We will explain our procedures to your child in terms designed to be pleasant and non--threatening.  The first visit is not uncomfortable and should be a positive experience for you and your child.

WHAT DO YOU DO AT THE FIRST VISIT?
            At the first visit your child’s medical and dental history will be reviewed.  A head and neck examination will be completed.  Your child’s teeth, oral tissues and jaws will be examined.  Your child’s teeth may be cleaned and polished (unless your child has several areas of decay or is very young) and a fluoride solution or coating may be applied.  Dental radiographs (x-rays) of your child’s teeth may be obtained.  Brushing and flossing instructions will be given and reviewed so that your child may do a better job of maintaining proper oral health.  Nutrition may be reviewed.  After these procedures have been completed, the doctor or a staff member will meet with you to review the findings, to make recommendations and to answer any questions you may have.

HOW OFTEN SHOULD I TAKE MY CHILD TO THE PEDIATRIC DENTIST?
            After the doctor has evaluated your child at the initial visit, he will recommend a course of treatment and regular checkups individualized for your child.  Both the American Academy of Pediatric Dentistry and the American Dental Association recommend two evaluations per year, about six months apart. Generally we recommend that your child be seen twice yearly for examinations, a professional cleaning and the application of fluoride supplements.  Children with no cavities or those with exceptional oral hygiene may be seen less frequently. Children with a high incidence of dental decay or very poor oral hygiene may be seen much more frequently until such time as their oral hygiene has improved and their cavity rate has reduced.  Due to the difficulty in keeping their teeth clean, children in braces will generally need to be seen more frequently.

WHY VISIT THE DENTIST TWICE A YEAR WHEN MY CHILD HAS NEVER HAD A CAVITY?
            Regular dental visits help your child stay cavity-free.  Regular teeth cleanings remove debris that builds up on the teeth, irritate the gums and cause cavities or gum disease.  Fluoride treatments renew the fluoride content in the enamel, strengthening the teeth and preventing cavities.  Hygiene instructions improve your child’s brushing and flossing leading to cleaner teeth and healthier gums.  Tooth decay isn’t the only reason for regular dental visits.  A pediatric dentist provides an ongoing assessment of changes in your child’s oral health.  For example, your child may need additional fluoride, dietary changes or sealants for ideal dental health.  Orthodontic problems may be identified and prompt corrective measures undertaken.

WHAT HAPPENS AT A DENTAL CHECK-UP?
            Your child’s medical and dental history will be reviewed.  A head and neck examination will be completed.  Your child’s teeth, oral tissues and jaws will be examined.  Your child’s nutrition and diet may be reviewed.  Your child’s teeth will be cleaned and polished (unless your child has several areas of decay) and a fluoride solution will be applied.  Dental x-rays may be obtained.  Brushing and flossing instructions will be given and reviewed so that your child may do a better job of maintaining proper oral health.  

HOW OFTEN SHOULD A CHILD HAVE DENTAL X-RAYS?
           Since every child is unique, the need for dental x-rays varies from child to child. Without appropriate x-rays certain dental conditions can and will be overlooked. In this office, dental x-rays are only taken after a review of your child’s medical and dental health history, and only when it is felt that dental x-rays are likely to yield information that a visual examination cannot.  In general children require x-rays more often than adults.  Their mouths grow and change rapidly.  Children are more susceptible to decay than adults.  The American Academy of Pediatric Dentistry and the American Dental Association recommend x-ray examinations every six months for children with a high risk of tooth decay.  Children with a low risk of tooth decay require x-rays less frequently.

WHY SHOULD X-RAYS BE TAKEN IF MY CHILD HAS NEVER HADA A CAVITY?
            X-rays detect much more than cavities.  For example, x-rays may be required to survey erupting teeth, diagnose bone disease, evaluate the results of an injury or to plan orthodontic treatment.  X-rays assist dentists in diagnosing and treating health conditions that cannot be detected by a clinical examination alone.  Finding and treating dental problems early can save you time and money and can save your child much in the way of discomfort.
                   
ARE X-RAYS TAKEN ROUTINELY?
            In this office there is no such thing as routine dental x-rays.  X-rays are recommended only when necessary to protect your child’s dental health and to assist us in the diagnosing of cavities or other dental conditions.  The frequency of x-rays is determined by your child’s individual needs.

HOW SAFE ARE DENTAL X-RAYS?
            We make every attempt to reduce the radiation exposure incurred by your child.  When possible we use digital (computer generated) x-rays which reduce the radiation exposure.   Using digital x-rays along with contemporary safeguards, such as radiation blocking barriers, minimizes the amount of radiation received in a dental x-ray examination.  The risk is negligible.  In fact dental x-rays represent a far smaller risk than an undetected and untreated dental problem.

HOW WILL MY CHILD BE PROTECTED FROM X-RAY EXPOSURE?
            Lead body aprons and shields will be used to protect your child.  We use equipment that filters out unnecessary x-rays and restricts the x-ray beam to the area of interest.  Digital radiographs and proper shielding assure that your child receives a minimal amount of radiation exposure.   

HOW CAN I HELP MY CHILD ENJOY GOOD ORAL HEALTH?
            The following steps will help your child be part of the cavity-free generation:

1. Beware of frequent snacking,
2. Eat a balanced nutritive diet.
3. Brush at least twice a day with a fluoride toothpaste,
4. Floss at least once a day (always floss before brushing),
5. Have sealants applied when appropriate,
6. Seek regular dental check-ups, and
7. Assure proper fluoride intake through drinking water, fluoride products or supplements.

HOW SHOULD I CARE FOR MY CHILD'S TEETH?
            Prior to the eruption of the first primary (baby) tooth, several times daily, preferable after feedings, you should wipe your child’s mouth with a warm cloth to cleanse the gums and remove food particles and bacteria.  With the eruption of the first tooth, you should gradually move to the use of a small toothbrush having soft bristles. If practical, brush after each meal but at least twice daily.  The most important time to brush is before bedtime. Use a small pea or pinky fingernail size amount of fluoride containing toothpaste, and if your child is unable to spit out the toothpaste, using a soft warm cloth clean the toothpaste from the mouth.  Brush the teeth in a circular motion and be sure to brush the inside, outside and top of the teeth.  Brush both the top and bottom teeth and gently brush the tongue as well.  Until the age of 7 or 8 most children do not have the dexterity or the desire to brush or floss their teeth effectively; for this reason until your child is about 7 or 8 years old we recommend that a parent actually brush the teeth.  You may be able to allow your child to brush independently at an earlier or later age depending upon each child’s individual development and muscular coordination.
            Although you need not floss until multiple teeth have erupted and are touching, starting to floss at an earlier age develops good habits.  Most younger children (under the age of 7 or 8) lack the coordination to floss their teeth, so we recommend that the parents actually floss the teeth, at least once daily.  You should always floss before you brush the teeth.  Flossing loosens up and removes debris caught between the teeth and the toothbrush then brushes those particles out of the mouth.
            As part of our initial and periodic examinations we will show you and your child how to properly brush and floss his or her teeth.

WHAT TYPE OF TOOTHBRUSH SHOULD I USE?
            We do not recommend any particular brand of toothbrush or a manual or a powered model.  Whichever one feels comfortable to you and fits your child’s mouth comfortably should work fine.  However, we do recommend only soft-bristle toothbrushes.  There is no need to use medium or hard bristle toothbrushes.  Over a period of time, using medium or hard bristle toothbrushes actually damage the teeth by removing valuable protective enamel.
            The toothbrush should bear the ADA Seal of Acceptance.  The Seal assures that the toothbrush has been independently evaluated and has been found to be safe and effective; i.e., the bristles are not sharp or jagged, the handle is made of a durable material, and the bristles will not fall out with normal use.  Powered models must also meet the requirements of a safety laboratory such as the Underwriters Laboratory of Northbrook, Illinois.

DO I HAVE TO TAKE CARE OF THE TOOTHBRUSH?
            Yes. After brushing the teeth, rinse the toothbrush with tap water.  This removes food particles, debris and toothpaste from the bristles.  The brush should be stored standing upright so that it may air dry between uses.  Try to keep the bristles of adjacent toothbrushes from touching, this helps prevent the spread of bacteria.  Don’t store the toothbrush in a closed container, this promotes bacterial growth.
            Toothbrushes have a limited life span and should be replaced when the bristles are frayed, worn or bent; about every 3 months. Younger children, and those patients with special needs, have a tendency to chew on their toothbrushes so you may need to replace them even more frequently.  Toothbrushes having frayed, worn or bent bristles do a poor job of cleaning.  Compared to the cost of fixing a cavity, a toothbrush is very inexpensive; replace them often!

WHAT TYPE OF TOOTHPASTE SHOULD MY CHILD USE?
            Check to be sure that the toothpaste caries the Seal of Acceptance from the American Dental Association.  This seal ensures that the toothpaste conforms to certain standards to be sure that they are safe and effective.  The toothpaste should contain fluoride, however, for the very young child (less than 2 years old) or for the child that cannot spit out the toothpaste, it is better to use a non-fluoride containing toothpaste.

WHAT TYPE OF FLOSS SHOULD I USE?
            We do not recommend any particular brand of floss.  Unwaxed floss has a tendency to fray and trap more food and plaque.  Waxed floss tends to glide between the teeth more easily and is especially helpful for children have tight contacts (teeth close together).  Whichever one feels comfortable to you and works in your hands should work fine.

WHY DOES MY CHILD'S DIET MATTER?
            Good nutrition leads to good health and good teeth.  Poor nutrition and a diet rich in sweets and soda leads to poor health and poor teeth. Children should eat balanced meals rich in fruits and vegetables and should limit sweets.  If you are going to give your child a sweet, the best time to do so is right after a well balanced meal.  Sticky sweets are not as good as a sweet that is rapidly eliminated from the mouth.  More frequent snacking is associated with a higher incidence of dental decay and obesity.

WHAT IS A HEALTHY DIET FOR MY CHILD?
            A healthy diet is a balanced diet that naturally supplies all the nutrients your child needs to grow.  A balanced diet is one that includes the following major food groups every day: Fruits and vegetables; breads and cereals, milk and dairy products, meat, fish and eggs.  Limit processed foods and promote fresh vegetables and fruits.

HOW DOES MY CHILD'S DIET AFFECT HIS/HER HEALTH?
            A balanced diet is important for the proper development of teeth and for healthy gums.  A diet that is high in certain kinds of carbohydrates, such as sugars and starches, may place your child at extra risk of tooth decay.

HOW DO I MAKE MY CHILD'S SAFE FOR HIS/HER TEETH?
            First, be sure that he or she eats a balanced diet.  Limit foods with simple sugars or starch.  Foods with starches include breads, crackers, pasta, pretzels and potato chips.  Sugars can be found in many processed foods, even some which do not taste sweet.  For example a peanut butter and jelly sandwich not only has sugar in the jelly but may also have sugar added to the peanut butter.  Sugar may also be added to condiments such as ketchup and salad dressings.  Encourage your child to eat complex carbohydrates, including vegetables, fruits and whole grains.

SHOULD MY CHILD GIVE UP ALL FOODS WITH SUGAR OR STARCH?
            Of course not.  Many provide nutrients your child needs.  You need to select and serve them wisely.  A food with sugar or starch is safer for teeth if it is eaten with a meal and not as a snack.  Sticky foods such as toffee or dried fruit are not easily washed off the teeth by saliva.  Sticky foods have more cavity causing potential than foods more rapidly cleared from the teeth.

DOES A BALANCED DIET ASSURE THAT MY CHILD IS GETTING ENOUGH FLUORIDE?
            A balanced diet does not guarantee that your child is receiving the proper amount of fluoride for the development and maintenance of his/her teeth.  Your child may need fluoride supplementation during the years in which teeth form.  Check with your pediatric dentist to see whether your child needs additional fluoride.

MY YOUNGEST CHILD IS NOT ON SOLID FOODS YET.  ANY SUGGESTIONS?
            Do not nurse your child to sleep or put him or her to bed with a bottle of milk, formula, juice or sweetened liquid.  While your child sleeps, any unswallowed liquid in the mouth supports bacteria that produce acids and cause cavities.  Protect your child from severe decay by putting him or her to bed with nothing more than a bottle of water.

ANY FINAL ADVICE?
            Yes.  Shop smart.  Limit the purchase of sugary or starchy food. Limit junk food snacks. Provide a balanced diet and save foods with sugar or starch for mealtimes.  Do not put your child to bed with a bottle containing anything other than water. Limit chewing gum and soda.

WHAT IS A CAVITY?
            Simply speaking, a cavity is a hole in a tooth caused by bacteria dissolving away the protective enamel and/or other tooth structures.  Enamel is the outermost, white, hard surface of a tooth and dentin is the yellowish layer just beneath enamel. Both layers serve to protect the inner living tooth tissue called the dental pulp (nerve), where blood vessels and nerves reside. Small cavities may not cause pain, and may be unnoticed by the patient. Larger cavities can collect food, and the dental pulp of the affected tooth can become irritated by bacterial toxins, foods that are cold, hot, sour, or sweet - causing toothaches, pain, or swelling (abscess).  Not all cavities need to be restored.  If caught early, the use of fluoride containing toothpastes and gels as well as certain newer dental products can stop the progression of decay or even reverse the decay process.
           
HOW DO I PREVENT CAVITIES?
            Regular visits to the pediatric dentist, along with proper diet and good oral hygiene, can prevent most cavities.  Good oral hygiene removes food trapped on teeth as well as bacteria causing decay.  A well balanced diet strengthens your body and your immune system lessening, the chances of decay.  Regular dental care and examinations allow the pediatric dentist to review diet, oral hygiene and to exam the teeth and gums in an effort to prevent the formation or spread of decay.  The use of fluoride and sealants can lessen the chance of decay.  Both this office and the American Academy of Pediatric Dentists recommend recurring six month visits to the pediatric dentist beginning within 6 months of the eruption of the first primary tooth or by 1 year of age, whichever comes first.  Certain children may need to be seen more or less frequently.

WHAT ARE DENTAL SEALANTS?
            The chewing surfaces of the back teeth of children are the surface most susceptible to decay.  Studies show that 4 out of 5 cavities that develop in children under the age of 15 occur in the back teeth.  Dental sealants are designed to protect the chewing services of back teeth.  Made of a clear or shaded plastic-type material, sealants are applied to teeth to help keep them cavity free. Even the most diligent child can have trouble cleaning the deep grooves and pits of the back teeth.  Food and bacteria can become lodged in these areas, leading to the development of cavities. Sealants "seal out" or fill up the deep grooves and pits of these teeth and prevent food and bacteria from becoming lodged in those areas, thus preventing or reducing the development of cavities.  Sealants do not work between the teeth, so flossing remains important to protect those areas from decay.
            Research shows that sealants can last for many years.  Oftentimes, even if a sealant cannot be seen on a tooth, it remains in the grooves and pits thereby protecting the tooth.  The child who receives sealants can be protected throughout the most cavity prone years.  Sealants last longer on children who maintain good oral hygiene.  The pediatric dentist can easily repair or replace a lost or damaged sealant.
            Sealants are quickly and comfortably applied in one visit.  The tooth is conditioned to receive the sealant, washed and dried; the sealant is applied and cured (hardened) using an ultraviolet lamp.  Anesthetic is usually not required. Sealants are very affordable, especially in view of the valuable decay protection they offer to your child.  Sealants cost significantly less than most fillings and are often covered by dental insurance.
            The teeth at most risk for decay - and therefore most in need of sealants - are the six-year and twelve-year molars.  However, any tooth, primary or permanent, with deep grooves or pits may benefit from the protection of sealants.
            Sealants are only one step in the plan to keep your child cavity free for life.  Brushing, flossing and regular dental visits are still essential to the maintenance of a bright, healthy smile.

MY CHILD HAS SOME CAVITIES – BUT THEY ARE ON BABY TEETH AND BABY TEETH FALL OUT. WHY DO WE NEED TO FIX THEM?
            It is true that primary (baby) teeth are lost and replaced by the permanent teeth but until they are lost the primary teeth serve several important purposes.  They hold the space required for the permanent teeth and guide the permanent teeth into position, they allow for proper development of the jaw bones and muscles, they are needed for proper chewing and talking and they are important for proper esthetics.  Early extraction of primary teeth may require the placement of a space maintainer, which is an orthodontic appliance designed to maintain the space where the primary tooth was for the permanent tooth.  While we will extract teeth if indicated, saving the primary teeth is, in most instances, better than removing them.  Please note, some primary teeth are not lost until the child is 12 years of age.

MY CHILD IS VERY YOUNG – WILL YOU GIVE HIM/HER A SHOT?
            We will do everything we possibly can to make your child relaxed and comfortable so that he or she has a positive dental experience.  We do not use the term “shot” in our office.  This is a very negative term that scares most children and parents.  Instead we tell your child that we are going to put their tooth to sleep using “sleepy juice.”
            Should your child have cavities or other treatment requiring the use of a local anesthetic for pain control we will generally proceed as follows: we will administer nitrous oxide (“laughing gas”) until your child reaches a comfortable level, after which we will place topical anesthetic in the area to be anesthetized.  The topical anesthetic “numbs” the tissue in the area where we are going to administer the sleepy juice.  After allowing a few minutes for the topical anesthetic to take effect, slowly and gently we will administer the sleepy juice.  In most cases, using nitrous oxide, along with topical anesthetic reduces or eliminates any sensation of discomfort.
            In more involved cases or in cases involving younger children we may also use oral conscious sedation or recommend general anesthesia to accomplish the recommended treatment in a comfortable, pain and stress-free manner.

DO YOU USE NITROUS OXIDE IN YOUR OFFICE?
            Dental phobias are often responsible for the delay in seeking dental treatment experienced by many children and adolescents thereby causing the degree of dental decay and the resultant treatment to be more extensive and expensive.  As a pediatric dental specialty office, one of our prime concerns is trying to make each dental experience as pleasant as possible for each child.  For this reason we use nitrous oxide on children that we treat (of any age) undergoing operative treatment (fillings, etc.).  It is our experience that the use of nitrous oxide/oxygen calms the anxious child/adolescent/teenager making the dental experience more enjoyable and less frightening.  More treatment can be completed in each visit and the child is generally less traumatized by the dental experience.  We believe that nitrous oxide analgesia is one of the best tools that we have to make your child’s dental experience more pleasant.

WHAT IS ORAL CONSCIOUS SEDATION (minimal or moderate sedation)?
            Oral Conscious Sedation involves the administration of an agent (drug) or combination of agents designed to cause an alteration or alterations in the level of the child patient’s consciousness, cognition, motor coordination, degree of anxiety, and physiological parameters.  The changes experienced by a patient will depend upon the drug used, the amount used and each patient’s individual sensitivity to the agent(s) used.   When using oral conscious sedation, we are attempting to reach one of the following levels of sedation; (1) minimal sedation or (2) moderate sedation.  Minimal sedation is defined by the American Academy of Pediatric Dentistry as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands. Moderate sedation is defined by the American Academy of Pediatric Dentistry as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation.  Although we make every effort to keep patients in either a minimal or moderate stage of sedation, patients can move from one stage of sedation to another and can enter deeper stages of sedation including deep sedation and/or general anesthesia.
            Oral conscious sedation is designed to relax your child and increase your child’s cooperation thereby making the proposed dental treatment easier and more comfortable.  The duration of the sedation varies from child to child but is approximately 45 minutes to 1 hour for the actual dental treatment followed by another 4-6 hours during which your child will sleep or be sleepy/drowsy.  Oral conscious sedation is not always successful, in our office in approximately 10-15% of cases the oral conscious sedation does not work at all.  In those cases we may be unable to complete the proposed treatment or, in some cases, any treatment, and general anesthesia may be recommended as an alternative.  As with the administration of any medication, there are potential side effects to the use of oral conscious sedation (please see common risks below). 
            Indications for oral conscious sedation include but are not limited to:

1. preschool children requiring dental treatment who cannot understand or cooperate for definitive treatment;
2. patients requiring dental care who cannot cooperate due to lack of psychological or emotional maturity;
3. patients requiring dental care who cannot cooperate due to a cognitive, physical, or medical disability;
4. patients who require dental care but are fearful and anxious;
5. patients who require extensive dental care and require or would benefit from prolonged visits; or
6. patients who have failed treatment in other dental offices.

            Oral conscious sedation is induced by a drug or combination of drugs.  In our office we may use the following medications to achieve the level of sedation we are seeking: Chloral Hydrate (Noctec); Vistaril (Hydroxyzine pamoate); Atarax (Hydroxyzine hydrochloride), or Versed (Midazolam).  These medications may be given alone or in combination.  They may also be mixed with Ibuprophen. 
            A sedated child is closely monitored at all times. S/he will never be left alone!  S/he may be monitored with a pulse oximeter (measures oxygen saturation and heart rate), ECG (monitors heart function), capnograph (measures air exchange), blood pressure cuff, precordial stethoscope, and/or with visual and tactile stimuli.  At least one staff member will be present with the doctor at all times during the treatment phase of the oral sedation procedure.  Generally, during the oral conscious sedation treatment procedure your child receives supplemental oxygen and may be gently wrapped in protective stabilization (also termed a papoose board) for his/her protection.

BENEFITS AND ALTERNATIVES TO THE USE OF ORAL CONSCIOUS SEDATION

            Benefits include a reduction in anxiety/fear concerning dental care, the ability to receive dental services in an office environment, a reduction in cost when compared to receiving dental services in a hospital environment, minimal memory of the dental treatment, and the ability to accomplish more treatment in fewer visits.  Alternatives to the use of oral conscious sedation are: 1) attempting the proposed treatment without the use of oral conscious sedation, or 2) putting your child to sleep (general anesthesia - either in the hospital or in an office setting) utilizing the services of a medical or dental anesthesiologist.
Each of the alternatives has benefits and risks.  For example, attempting to treat your child without using oral conscious sedation may be an extremely unpleasant experience for your child (s/he may scream, cry and fight during treatment), it may create a lifetime fear of dentists and it may take more visits to complete the proposed treatment; therefore the doctor may refuse to treat your child unless oral conscious sedation is used.  Putting your child to sleep exposes your child to the risks of anesthesia and will increase the cost of treatment, but will allow all treatment to be completed in one visit.

COMMON RISKS TO ORAL CONSCIOUS SEDATION

THE MOST COMMON RISKS ARE LISTED BELOW – THIS LIST IS NOT MEANT TO BE ALL INCLUSIVE AND YOUR CHILD COULD EXPERIENCE RISKS NOT LISTED:

1. Nausea or Vomiting – the medications may upset your child’s stomach causing him/her to become nauseated or to vomit.  This is more likely when Chloral Hydrate is used because it is considered to be a gastric (stomach) irritant.   Normally these problems spontaneously resolve in a short period of time and no treatment or intervention is required.
2. Paroxysmal reaction to the medications – In approximately 10-15% of cases, instead of being sedated or relaxed, the medication causes an increase in irritability or excitability in your child, manifested by movement, fidgeting, screaming, etc.  Generally, once nitrous oxide (laughing gas) inhalation has begun this behavior will cease, but if it does not, treatment may need to be postponed. 
3. In some cases your child could experience the following; hypotension (decreased blood pressure), hypertension (increased blood pressure), deep unarousable sleep, bradycardia (decreased heart rate), hypoventilation and/or respiratory depression (reduced breathing), airway obstruction, apnea (cessation of breathing for a time period), allergic reaction to the medications or death.  These may require emergency medical attention.

WHAT IS GENERAL ANESTHESIA?
            Children having extensive treatment needs, acute situational anxiety, uncooperative age-related behavior, disabilities or medical conditions may not be able to receive dental care in a traditional manner.  These children may require the use of general anesthesia to receive care in a safe and caring manner.  General anesthesia is a drug induced loss of consciousness. While we can treat these children at a hospital or outpatient surgical facility, treatment at these facilities may not be covered by insurance and can be cost-prohibitive.  As an alternative we offer the services of a dental anesthesiologist who provides in-office IV sedation and/or general anesthesia.
            Using the services of a dental anesthesiologist offers many benefits for the patient and parent.  Access to care is improved, i.e. the patient can be treated in a safe and humane manner. All treatment can be completed in one sitting, and the cost for the services, while slightly higher than the use of oral conscious sedation, is significantly less than the cost of hospital or ambulatory surgery center based services.  By gaining the patient’s cooperation, the quality of dental care is improved.  Your child will have little to no recollection of the procedures completed. 
            Briefly, treatment in the office using deep sedation/general anesthesia is accomplished as follows: 1) your child should have nothing to eat for 8 hours prior to the appointment and nothing to drink for at least 6 hours prior to the appointment, 2) on the date of the treatment appointment, bring your child to the office in comfortable loose fitting clothing.  Bring a change of clothing or a diaper with you (many children as they go to sleep will void), 3) the anesthesiologist will review their treatment with you (they will have also reviewed their treatment with you on at least one other occasion), 4) after answering any questions you might have, reviewing your child’s health history and determining that it is safe to put your child to sleep, an intramuscular injection will be administered, generally in the upper arm. 
            Your child will remember nothing after this time. Within 3-5 minutes your child will be asleep.  A blood pressure cuff, pulse oximeter, EKG pads and a capnograph will be attached to monitor your child. An IV will be started, generally in their right hand, so that fluids and additional medications can be administered.  After this has been done the dentistry will be completed, after which the medications will be turned off and your child will start to wake up.  After approximately 15-30 minutes your child will be awake enough so that s/he may go home.  S/he will still be groggy, but will have recovered to the point that leaving the office is safe.  For the remainder of the day “baby” your child.  Call us if you have any concerns or questions.
            We find that we are recommending the use of in-office general anesthesia using the services of the dental anesthesiologist more and more frequently.  We have determined that treating children while they are asleep is advantageous compared to treatment using oral conscious sedation.  If you are uncomfortable with in-office general anesthesia, please discuss with us the use of hospital or ambulatory surgical based anesthesia and treatment.

WHAT IS NURSING OR BABY BOTTLE CARIES?
            Nursing or baby bottle caries (presently called early childhood caries) are one of the most serious type of dental decay a child can have.  This condition is caused by early, frequent and long exposure of an infant or child’s teeth to sugar containing liquids.  These liquids include cow’s milk, breast milk, formula, fruit juice, pop or other sweetened drinks.  Placing a baby to sleep with a bottle containing anything other than water may expose the child to early childhood caries.  As the child falls asleep, s/he does not swallow the last sip of the fluid and the tongue pushes the fluid forward to the upper front teeth where the bacteria in the mouth cause the production of acid.  The acid begins to dissolve the enamel on the teeth and cavities may develop quickly.  Early childhood caries generally affects the upper front teeth first, quickly progress to the upper posterior teeth and then attacks the lower posterior teeth.  If left untreated, early childhood caries can cause the premature loss of teeth as well as the need for extensive dental treatment to restore the damaged teeth.  Prolonged use of a sippy cup can also cause early childhood caries due to the present of the sweetened liquid in the mouth for extended periods of time.
            To prevent early childhood caries, after each feeding wipe your child’s teeth and gums with a damp washcloth or use a toothbrush to remove the fluid and bacteria that is present. Encourage your child to drink from a cup as s/he approach his or her first birthday.  Children with teeth should not fall asleep with a bottle, sippy cup or when breast-feeding.  At-will feeding should be avoided once the first primary tooth has erupted.  Juices, milk and other liquids should be taken from a cup.

WHEN SHOULD BOTTLE-FEEDING BE STOPPED?
            Children should be weaned from the bottle at 12-14 months of age.  If you go from using a bottle to using a sippy cup, the sippy cup should only contain water, no juices.

HOW LONG CAN MY CHILD USE A PACIFIER?
            Whether to use a pacifier is a personal choice.  The American Academy of Pediatrics (AAP) convened a Task Force on Sudden Infant Death Syndrome (SIDS).  As a result of the work of the task force the AAP issued a Policy Statement in 2005 that gives guidance on the proper use of the pacifier.  The policy states:

            “Consider offering a pacifier at nap time and bedtime:  Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling . . .   The task force recommends use of a pacifier throughout the first year of life according to the following procedures:

            • The pacifier  should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep.  If the infant refuses the pacifier, he or she should not be force to take it.

            • Pacifiers should not be coated in any sweet solution.

            • Pacifiers should be cleaned often and replaced regularly.

            • For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.”

American Academy of Pediatrics, Policy Statement, Pediatrics 2005:116-1245-1255.

            Allowing your child to use the pacifier until the age of 1 should present no problem and should reduce the incidence of SIDS.  Continued use of the pacifier after age 3 may contribute to orthodontic and orthopedic changes of the mouth.

TEETHING – WHAT IS IT AND WHAT SHOULD I DO?
            Teething, the process of the eruption of teeth, is a normal occurrence and in many cases is preceded by an increase in salivation (drooling) and an increase in the child placing his/her hands and fingers into the mouth. The child may experience some discomfort as the tooth nears eruption due to the crown of the tooth pressing on the gum tissues.  More serious problems, such as fever and diarrhea are generally not associated with teething.  Experiencing a fever while teething is most likely a coincidence and not related to the actual process of teething. 
            The primary teeth start forming even before your child is born.  The timing of the eruption of the primary teeth varies but one can usually expect the first primary tooth to erupt between 6-9 months of age with the last primary tooth erupting around 28-32 months.  There are a total of 20 primary teeth, 10 upper and 10 lower.  The first permanent tooth that erupts is often the six year molar (first molar) and that tooth erupts in back of the last baby tooth, often around 6 years of age.  There are usually 28-32 permanent teeth, the lesser number being seen when the 3rd molars (wisdom teeth) have failed to form.  Generally, girls get and lose their teeth at an earlier age than boys.  It is not unusual to see a young girl gain or lose her teeth 6-9 months before her brother would.

WHAT SHOULD I DO IF MY CHILD HAS A TOOTHACHE?
            Have your child rinse the irritated area with warm salt water (8oz. of warm water with 1 tsp. of salt).  Place a cold compress on the face if it is swollen.  If you can see a “pimple” on the gum near the tooth, place a warm compress on the pimple. Give the child acetaminophen or ibuprophen for any pain.  Do not place aspirin directly on the teeth or gums; it will burn the gum tissue.  Call the office to schedule a time for your child to be seen.

MY CHILD IS HAVING A DENTAL EMERGENCY – WHAT SHOULD I DO?
            If your child is having a true dental emergency, one where trauma or bleeding is involved, please call the office immediately and, if the office is open, you will be asked to bring your child in immediately so that s/he can be evaluated and treated.  If it is an after- hours emergency, the office answering system will page the doctor on call who will call you to discuss the nature of the emergency.  If required, the doctor will meet you and your child at the office to treat your child, or the doctor may recommend that your child be seen at the nearest emergency room.  Please note, we distinguish between a true emergency and what we term a perceived emergency.  Toothaches are rarely a true emergency and often are a result of failure to follow through on previously recommended treatment.

            Knocked out tooth - If your child has knocked a permanent tooth completely out of its socket (dentists call this “avulsion”), remain calm, then find the lost tooth.  Hold the tooth by the crown. Do not wipe the tooth clean. Gently rinse the tooth off to remove any visible debris and, if you are comfortable doing so, place the tooth back into the socket.  Have your child or someone else gently hold the tooth in place and see your dentist immediately.  If you are not comfortable placing the tooth back into the socket, place the tooth in a glass of milk (skim or low fat is best) or Hanks balanced salt solution, if available. If these are not available, use a wet napkin or cup of water or if your child is old enough, have them hold the tooth in their mouth under their tongue. See your dentist immediately. If a tooth is placed back in its socket soon enough by your dentist (less than 1 hour) the tooth may be saved. The amount of time the tooth is out of the socket is critical.
            Avulsed primary (baby) teeth are generally not reimplanted, the success rate for reimplantation is very poor and may cause future problems, such as ankylosis.  If you are unsure whether your child has knocked out a primary or permanent teeth, err on the side of reimplanation and place the tooth back into the socket.  See your dentist immediately.

            Loosened teeth - if your child has had an accident and his/her tooth has not been knocked out but has only been loosened, depending on how loose the tooth is, your dentist may leave the tooth alone and allow it "tighten-up" on its own or may splint the loose tooth to firm uninjured teeth for support.  If the tooth requires splinting, generally it will be splinted for 7-10 days, after which the splint will be removed.  Traumatized teeth may turn dark and/or abscess after an accident, requiring further treatment up to an including root canal therapy or extraction. A traumatized tooth may turn dark soon after the trauma, or years later.

            Cut/lacerated lip or tongue - apply pressure to the cut to stop or slow the bleeding. If the bleeding is severe or you cannot get the bleeding stopped, go to the nearest Emergency Room immediately. The cut or laceration may require stitches to stop the bleeding, to prevent infection and to help it properly heal.

            Chipped/fractured tooth – if possible find the chipped piece of tooth and place it in water.  Your dentist may be able to attach it back to the tooth.  Call your dentist so that he or she may evaluate the chipped tooth. X-rays may be obtained to check the severity of the damage and to see if the root has been damaged and whether the tooth is able to be saved.  Eat a soft diet for the next 3 days.  Don't chew on anything hard.  Some teeth will need root canal therapy and more extensive cases may require extraction.

WHAT IS ANKYLOSIS?
            Teeth are held in the mouth by fibers that form the periodontal ligament.  Sometimes the fibers are replaced with bone and the tooth becomes fused to the bone preventing the tooth from erupting. The exact cause of this condition is still uncertain although theories include genetics and trauma. As the areas adjacent to the ankylosed tooth continue to develop, the ankylosed tooth appears “submerged” compared to the erupting teeth.  Ankylosis can happen in both primary ("baby") teeth and permanent teeth and is more common in the primary lower molars. An exam and x-ray are the main diagnostic methods for determining ankylosis.  Tapping on an ankylosed tooth will reveal a solid sound as compared to a non-ankylosed tooth. Management of an ankylosed tooth starts with early recognition and diagnosis.  Many ankylosed teeth will be lost normally and require no treatment other than periodic evaluation. Some ankylosed teeth interfere with the eruption of the permanent teeth and require extraction.

WHY DO YOU USE OR RECOMMEND FLUORIDE FOR MY CHILD?
            Community water fluoridation started over 60 years ago in Grand Rapids, Michigan.  Since that time it has been determined that community water fluoridation is the single most effective public health measure to prevent tooth decay.  The Centers for Disease Control and Prevention proclaimed water fluoridation as one of the 10 greatest public health achievements of the 20th century.  Studies consistently show that the use of fluoride is one of the safest and best ways to reduce the incidence of cavities.   Fluoride is naturally present in all water.    Children and adults who are at low risk of dental decay can stay cavity-free through frequent exposure to small amounts of fluoride. This is best gained by drinking fluoridated water and using a fluoride toothpaste twice daily.  Children and adults at high risk of dental decay may benefit from using additional fluoride products, including dietary supplements (for children who do not have adequate levels of fluoride in their drinking water), mouthrinses, and professionally applied gels and varnishes. Unbiased scientific evidence supports the use of fluoride dental products for preventing tooth decay for both children and adults.  Fluoride's main effect occurs after the tooth has erupted above the gum. This topical effect happens when small amounts of fluoride are maintained in the mouth in saliva and dental plaque.  Fluoride works by stopping or even reversing the tooth decay process. It keeps the tooth enamel strong and solid by preventing the loss of (and enhancing the re-attachment of) important minerals from the tooth enamel.
            Tucson’s water supply is not fluoridated even though the Tucson City Council approved the addition of fluoride to the water supply many years ago.  The City has not funded this project yet.  There is some naturally occurring fluoride in the Tucson water.  The amount of fluoride varies from well site to well site and is dependent upon the percentage of Colorado River water added.  Although some children will benefit from the use of fluoride vitamins, prior to prescribing such vitamins we request that you obtain a water fluoride level from your local water company.   Generally with the use of a fluoride toothpaste and with periodic topical fluoride administered at our office, the use of supplemental fluoride in a vitamin is not necessary.

WHAT IS FLUOROSIS?
            In certain circumstances, a child may receive too much fluoride during the tooth formation years. Too much fluoride can result in defects in tooth enamel.  In mild cases of Fluorosis, the teeth may have small white specks or streaks.  These are often barely noticeable and present little esthetic concern.  In moderate and severe cases the enamel may be brown or black or may be pitted, rough, and hard to clean and present a real esthetic challenge.
            Fluoride is good for developing teeth, it strengthens the teeth and helps prevent dental decay.  However a child that ingests too much fluoride for that child's size and weight during the years of tooth development is at risk for Fluorosis. A child can ingest too much fluoride in several different ways. A child may take more of a fluoride supplement than the amount prescribed or a child may be given a prescription for a fluoride supplement when there is already an optimal amount of fluoride in the drinking water. Using too much of a fluoridated toothpaste and swallowing the toothpaste rather than spitting it out can also cause Fluorosis.
            Preventing Fluorosis begins with a conversation with your pediatric dentist.  He or she will review your child’s fluoride intake.  They may recommend that your drinking water be tested for fluoride content.  They you can decide whether fluoride supplementation is warranted.

WHAT ARE ATHLETIC MOUTH GUARDS?
            Once your child begins to participate in sporting activities s/he should be fitted for and should wear an athletic mouth guard.  Athletic mouth guards or protectors are made of soft plastic.  They are adapted to fit comfortably to the shape of the upper teeth.  Mouth guards protect not just the teeth, but the lips, cheek and tongue.  They help protect your child from head and neck injuries such as jaw fractures.  Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes.  Research shows that most oral injuries occur when athletes are not wearing mouth protection.

WHEN SHOULD MY CHILD WEAR A MOUTH GUARD?
            Whenever he or she is in an activity with a risk of fall or of head contact with other players or equipment.  This includes football, baseball, basketball, soccer, hockey, skateboarding, and even gymnastics.

HOW DO I CHOOSE A MOUTH GUARD FOR MY CHILD?
            Any mouth guard works better than no mouth guard.  Choose a mouth guard that your child can wear comfortably.  You can select from several options.  You may obtain a preformed or boil-to-fit mouth guard in a sports store.  Different types and brands vary in terms of comfort, protection and cost.  Your pediatric dentist can make customized mouth guards.  These are more expensive, but in general are more comfortable, fit better and are more effective in preventing injuries.

MY CHILD GRINDS HIS TEETH, WHAT SHOULD I DO?
            Grinding of teeth, also known as bruxism, is a habit developed by up to 15% of all children and young adults.  It is more frequently experienced at night time and can result in abrasion or wear of the permanent and primary teeth. The cause of bruxism varies and may be related to stress (going to school, moving), inner ear pressure, or improper bite (occlusion).  The majorities of cases of bruxism experienced by the pediatric patient do not require intervention or treatment and will spontaneously resolve.  Most cases will have resolved by the time the child is 9-10 years of age.  For those cases where intervention is warranted, a night guard may help. 

WHAT IS A NIGHT GUARD?
            A night guard looks very much like an athletic mouth guard but is generally custom made to fit over the teeth properly.  Night guards are made of a soft type of plastic material. Night guards protect the teeth from wear and are worn at night.  Disadvantages to the use of a night guard include interference with jaw growth, cooperation in wearing the appliance, and choking from the appliance becoming dislodged at night.

IS THUMB SUCKING A CONCERN?    
            Sucking is a natural reflex and comforts the young child.  Children may suck on various objects including their fingers, thumbs, pacifiers or washcloths.  The sucking habit may be considered normal during the first 2 years of life but should stop by the time the child is 4.  Whether thumb or object sucking is problematic depends on the duration of the habit and the force used during the habit.  Children who suck for extended periods of time as well as those who suck forcefully are more likely to develop dental problems.  Children who continue to suck as the permanent teeth erupt may experience a collapse in the maxillary arch and flaring of the erupting permanent front teeth.  Pacifiers, sippy cups and washcloths can cause the same problems as thumbs or fingers.
            Until your child is about 2-3 years old you should make no or little reference to the fact that they suck.  Telling your child that only babies suck their fingers negatively reinforces the habit and may make breaking the habit much more difficult.  Most children stop sucking by themselves or stop when they go to preschool or kindergarten where peer pressure is involved.  If you want you child to stop sucking and they also want to stop there are positive methods to use to get your child to stop.  Please discuss these with your pediatric dentist.

            There are several books that may be helpful in understanding and stopping thumbsucking.  They include:
            David Decides About Thumbsucking – A Story for Children, A Guide for Parents by Susan Heitler, Ph.D.
            Harold’s Hideaway Thumb by Harriet Sonnenschein

ORAL PIERCINGS - WHY NOT?
            More and more people, including teenagers, have oral piercings involving the tongue, lips or cheeks.  While such body art may seem innocent enough, it can be quite dangerous. The dental literature is replete with documented cases of oral piercings causing chipped or cracked teeth, infection, bleeding problems or other problems. The mouth is a relatively dirty environment containing millions of bacteria just looking for a place to infect.  Your tongue is loaded with blood vessels, any of which can be damaged during the piercing leading to life-threatening bleeding. Your tongue could swell and interfere with your ability to breath.  Nerves can be damaged during the piercing leading to life long numbness in that area.  So follow our advice, as well as that of the American Dental Association, skip the mouth jewelry.  However, if you are going to get oral piercings at least remove the jewelry during sporting events to reduce the incidence of trauma.

TOBACCO IS NOT COOL.
            Tobacco in any form can damage your child’s health and the health of those in contact with him. 90% of tobacco users become addicted to the use of tobacco. Nicotine, the addictive agent in tobacco, is one of the most additive agents known.  Cigarette smoking also affects nutrition.  Smokers tend to have a lower intake of numerous essential nutrients such as Vitamin C and A.  Some nutrients affected by smoking have been associated with a reduced risk of lung cancer, a disease at which the smoker is of high risk of developing.  Tobacco use has also been considered a gateway to the subsequent introduction and use of other drugs or alcohol.  Smokers are more likely to drink than non-smokers and smokers are 10-30% more likely to use illicit drugs than non-smokers.
            Smokers can develop oral cancer.  The early signs of oral cancer generally do not include pain so oral cancers may be detected later than other forms of cancer.  If not caught early, oral cancers can require extensive surgery that may leave the person disfigured and can kill. If you or your child smoke watch for the following:

1. White or red leathery areas on the inside of the cheeks, lips or under the tongue.  Look very closely in the area where the cigarette or snuff is held in the mouth.
2. Sores that just don’t heal.
3. Difficulty on chewing or swallowing.
4. Sore throat of longer than normal duration.
5. Pain, tenderness or numbness in the mouth or lips.
6. A change in the way the teeth fit together.
7. Gingival recession, swelling or bleeding.

WHAT IF MY CHILD NEEDS BRACES?
            The pediatric dentist is specially trained to intercept and treat malocclusions (bad bites) in children.  Many malocclusions can be recognized in the 2-3 year old child.  That is not to say that the malocclusion should be treated at that time, because the 2-3 year old child is rarely cooperative enough for orthodontic treatment to be undertaken.  However, early orthodontic intervention can often reduce or eliminate more severe orthodontic problems later. At each visit the pediatric dentist should evaluate your child’s jaw growth and development to be sure they are developing normally.  The pediatric dentist will be concerned about early tooth loss, the development of habits such as bruxism and digit sucking and their effect on growth and development.  The pediatric dentist may recommend intervention to correct growth and developmental problems.
 
MY CHILD NEEDS AN EXTRACTION – WHAT IS THAT?
            An extraction is the complete removal of a primary or permanent tooth.  Extractions can be surgical or non-surgical depending on the difficulty of the extraction, the amount of tooth structure remaining, whether or not the tooth is impacted or erupted, and whether it has straight or curved roots.  We do most extractions in our office believing that as a pediatric dental office we are best suited to remove/treat the teeth of children.  However, difficult extractions may be referred to an Oral Surgeon (someone who specializes in difficult or surgical extractions).  Although most extractions are atraumatic, we use nitrous oxide analgesia, local anesthesia and/or sedation dentistry to make sure your child’s experience is a pleasant as possible.
            There are many reasons why your child might require an extraction.  These include:

1. The tooth may be badly decayed and not be able to be saved,
2. The tooth may be abscessed (infected),
3. The tooth may be blocking the eruption of a permanent tooth,
4. The tooth may be ankylosed,
5. The tooth may be impacted,
6. Your orthodontist may request extractions for proper orthodontic treatment.

            Depending upon the reason for the extraction and the age of your child, we may recommend the placement of a space maintainer.

WHAT IS A SPACE MAINTAINER?
       When a child prematurely loses a primary tooth, teeth on either side of the lost tooth may drift or shift and cause a loss of space or other complications.  A space maintainer is a dental appliance designed to hold the space of the lost tooth until such time as the permanent tooth replacing the lost tooth has erupted or until orthodontic treatment can be instituted.  Space maintainers come in different sizes, shapes and materials.   

HOW LONG WILL MY CHILD'S FILLINGS LAST?
            We would like to tell you that your child’s fillings will last forever, or at least until they lose the tooth with the filing, but we cannot.  Unfortunately nothing lasts forever and nothing that the dentist does is as good as the original undamaged tooth.  Fillings replace tooth structures lost as a result of dental decay and help maintain tooth health, structure and function.  But they are never as good as the original tooth.  Here is a breakdown of our success rate with various dental materials.

            Stainless steel crowns (SSC) - Stainless steel crowns are the restoration of choice for a child’s tooth that is badly decayed, broken down or has had root canal therapy (pulpotomy or pulpectomy).  A SSC covers the entire crown of the tooth and protects the tooth from breakage.  SSC’s are designed to last until the primary (baby) tooth is lost or, if placed on a permanent tooth, until the child has matured enough that a more permanent type of restoration (porcelain crown) can be placed. SSCs placed in our office generally last until your child loses the tooth that the stainless steel crown has been placed upon.  Failure rates for stainless steel crowns are less than 1% per year, in Dr. Auerbach’s treatment experience.
 
            Composite restorations (tooth colored or white fillings) – This is a tooth colored material bonded to the tooth after decay is removed.  Composite is used for esthetic and restorative reasons.  Composite has several components and is the material of choice for a front tooth or in a circumstance where esthetics may be a consideration.  It may also be placed in posterior teeth.  The newer composite materials are strong and resist wear, but not as well as normal tooth structure.  The placement of composite is technique sensitive and therefore requires more chair time than amalgam restorations.  Composites placed on posterior primary teeth will generally last 5 -7 years or until the primary tooth is lost.  Those placed on anterior primary teeth undergo a higher failure rate but most will last until the primary tooth is lost.  Composites placed on permanent teeth will generally last 5-7 years.  In Dr. Auerbach’s treatment experience, composites fail at a 2-4% yearly rate.

            Amalgams – this is the silver mercury based material used for over 150 years in dentistry. We do not do this type of restoration but the success rate for amalgam is at least as good as that for composites.

            Composite faced/veneered anterior crowns – these are placed over the tooth and are comprised of stainless steel crowns having a facing or veneer of a composite type of material covering the front part of the tooth for increased esthetics.  They are placed on anterior teeth.  They require greater tooth removal than other types of anterior restorations and may require a root canal be completed as well.  These have about a 25% failure rate per year wherein the facing or veneer/ shears off or the entire crown is lost.

            Composite faced/veneered posterior crowns – these are tooth colored crowns placed on posterior teeth and have an approximately 100% failure rate per year wherein the composite facing/veneer will chip off leave the underlying stainless steel crown exposed.  Due to the extremely high failure rate of this type of restoration we do not perform this procedure in our office.

            Strip or resin anterior crowns – similar to composite faced crowns in that the entire tooth is covered by the restoration but in this type of restoration the entire crown is made of a composite material. There is no metal substrate. These can be placed on either anterior or posterior teeth.  Those placed on posterior teeth have a very high failure rate approaching 100%.  Those placed on anterior teeth are very esthetic but have approximately a 20% yearly failure rate.  Additionally, as your child grows, the margin of the strip crown (that part of the crown at or just below the gum tissue) may start to show and/or flake off.

            You can increase the longevity of your child’s restorations by following good oral hygiene and by eating a well balanced diet and by returning for periodic dental evaluations, cleanings and the administration of fluorides.

WHAT IS BONDING?
            Bonding is a procedure where tooth colored material (composite) is used to esthetically treat a tooth.  One of the more common uses of bonding is to close a gap between the front teeth or to repair a fracture on a front tooth.

WHAT IS A DENTAL CLEANING OR PROPHYLAXIS?
            The buildup of plaque and calculus (tartar) on the teeth and in the mouth causes bad breath, cavities and gum (gingival) problems.  While many can properly clean their teeth and prevent the buildup of these harmful materials, the pediatric patient often needs help in maintaining a clean mouth.  The pediatric dentist will generally want to examine your child at least twice yearly for their “check-up”.  Part of this check-up will include a dental cleaning (prophylaxis).  During the prophylaxis your child’s teeth will be flossed and then cleaned with a special fluoride containing toothpaste and/or special hand instruments or an ultrasonic cleaner to remove all plaque and calculus.  After this has been completed a fluoride gel or varnish may be applied.  Oral hygiene instructions will be reviewed.  This is all done in an effort to teach your child good oral hygiene habits and to reduce their incidence of decay.

WHAT IS A PULPOTOMY?
            A pulpotomy is a partial root canal on a primary tooth.  Both primary and permanent teeth are living (the “nerve”) with the nerve of the tooth extending from the root or roots of the tooth into the crown (the crown is that part of the tooth you see in the mouth).  In a pulpotomy procedure the top part of the nerve of the tooth, that part in the crown of the tooth is removed. A pulpotomy is often required when decay and bacteria are very near to the nerve or when removal of the decay and bacteria causes the nerve of the tooth to be exposed.  After removing that part of the nerve that is in the crown, a medication may be placed over the nerve stumps to protect the remaining nerve.  With very few exceptions, any tooth that has had a pulpotomy done on it should be protected with crown.  On posterior primary teeth a stainless steel crown is generally used.  On occasion a pulpotomy may be performed on an incompletely formed permanent tooth in an attempt to allow the roots of the tooth to continue to form.

WHAT IS A PULPECTOMY?
            A pulpectomy is the formal term for a complete root canal, whether done on a primary tooth or a permanent tooth.  In a pulpectomy procedure, the complete nerve of the tooth is removed using small instruments called reamers or files.  The canals of the teeth (where the nerve was in the root or roots of the tooth) are cleaned and a material is placed into the canals to prevent fluid or other material from entering the canal.  Teeth having a pulpectomy performed on them should be protected with a crown.   Primary teeth can have complete root canals done on them but the material placed into their canals should be resorbable so that as the root of the tooth is resorbed by the permanent tooth, the material is also resorbed.

WHAT IS TOOTH WHITENING OR BLEACHING?
            Tooth bleaching or whitening is a process by which the color of a stained or discolored tooth is changed to a lighter, more esthetic shade.  Bleaching or whitening requires the use of a mild acid that dissolves or bleaches some of the substrate of the tooth from the tooth. Over-the- counter whitening or bleaching products are safe and effective but are somewhat limited in the amount of whitening they can achieve.  They are much less expensive than dental administered bleaching.  In our office, if your child is unhappy with the color of their teeth we will generally recommend the use of an over-the-counter product to see if that product can help your child achieve the lightness desired.  If the over-the-counter product is not effective we can make custom bleaching trays for your child to use.

DOES YOUR OFFICE FOLLOW ALL INFECTION PROTOCOLS?
            We are very concerned about your child’s health and safety and take those steps possible to reduce the spread of disease in our office.  You will note that our office is well-maintained and carefully monitored by our dental staff.  When treating your child we follow all universal precautions including the use of personal protective equipment such as gloves, masks, and appropriate eye protection.  Gloves are used only for one patient after which they are discarded.  Several things occur in the office that you don’t even know occur; these are designed to protect you, your child and our staff.  Between patients the dental chair and treatment surfaces are cleaned and disinfected, all instruments are used only on one patient after which they are properly sterilized and stored, disposables are used where practical to reduce disease transmission and CDC approved hand soaps are used.  We want you to know that we meet or exceed all applicable infection control standards.

WHAT IS A FRENECTOMY?
            A frenum is a piece of tissue that connects the muscles of the lips and checks to the gums and tissues of the mouth.  There are several frenums present in your child’s mouth, the most noticeable ones being the frenum that attaches between or near the upper front two teeth (the labial frenum) and the one that holds the tongue down to the floor of the mouth (the lingual frenum).  Occasionally the frenums attach too high and cause gum rescession, spacing between teeth or a tongue tied situation. A frenectomy is a surgical procedure in which part or all of the problematic frenum is removed or repositioned in order to return a healthy situation to the mouth.  The vast majority of frenums need no treatment and surgical treatment of a frenum done in a young individual may cause orthodontic problems later; however a severely tongue tied child should have their frenum released at the earliest age practical.  To determine whether a lingual frenum need be treated you should determine whether the frenum is causing gum rescession or interferes with speech.  If the frenum does not cause either of these two problems, in most cases, the frenum need not be surgically treated.